I am writing in reply to the question about myocarditis and
hand-foot-mouth disease and the apparent lack of overlap between the two
even though both are frequently caused by Coxsackieviruses. (I
unfortunately deleted the original message). My educated guess is that
not all Coxsackieviruses are alike. In particular, there is Coxsackie A
and Coxsackie B viruses, and each is further described by multiple
I looked this up in "Pediatric Infectious Diseases: Principles and
Practice" edited by Jenson and Baltimore, 1995.
It seems that hand-foot-mouth disease is associated most often with
Coxsackie A16 (A9, A5, A10 less often) (p. 900).
The Coxsackie virus most often associated with myocarditis is Coxsackie B
serotypes 1 through 6; "the most severe disease has occurred with types 3
and 4". Of course, there are many other viral and non-viral agents
responsible for case of myocarditis.
I hope this has been somewhat helpful.
Gershon Segal, MD
Children's National Medical Center
Washington, DC 20010
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